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Abstract
Objective:
We hypothesised that patients with massive postpartum hemorrhage (PPH), defined as blood loss>1,500ml, may benefit from the use of activated recombinant factor VII (rFVIIa).
Design:
Retrospective cohort study.
Setting:
Department of Obstetrics & Gynaecology, Dow University of Health Sciences.
Population:
Thirty-four women with a diagnosis of massive PPH.
Methods:
All patients with PPH who were admitted to the Department of Obstetrics & Gynecology and Surgical Intensive Care Unit of Civil Hospital Karachi, Pakistan, were included in the study. From March 2005 to October 2006, 34 patients fulfilled the criteria of massive PPH, of which 18 received rFVIIa to control bleeding, and 16 patients did not. Availability and cost of rFVIIa were the factors in drug allocation.
Main Outcome Measures:
Maternal mortality, correction of coagulopathy, the amount of blood products transfused and preservation of fertility.
Results:
Patients receiving rFVIIa had lower maternal mortality (5/18, 28% versus 8/16, 50%, OR: 0.04 (0.002, 0.83)), and received a lower number of packed red cell transfusions (4.0±4.46 versus 9.61±6.7, p value 0.007), against the comparison group. Patients receiving rFVIIa had lower activated partial thromboplastin (median: 13.0; 25–75th percentile: −25.0, −8.0, signed rank p<0.0001), and lower prothrombin times (median: −8.8; 25–75th percentile: −24.2, −4.8), after administration of drug. There was no significant difference in the rate of hysterectomy between the 2 groups (11/18 (61%) versus 6/16 (38%)). No adverse event attributable to rFVIIa was observed in the study.
Conclusion:
Activated recombinant factor VII can be a life-saving drug in patients with massive PPH (Table 3).
| |
Total No. |
Maternal Mortality (%) |
OR |
95% CI |
| Treatment group |
|
|
|
|
| No rFVIIa |
16 |
50 |
Ref |
|
| RFVIIa |
18 |
22.2 |
0.29 |
(0.06, 1.26) |
| Delivery type |
|
|
|
|
| NVD/other |
12 |
41.7 |
Ref |
|
| LSCS |
21 |
28.6 |
0.56 |
(0.13, 2.48) |
| Cause of bleeding |
|
|
|
|
| Other medical/pregnancy/cervical |
10 |
50 |
Ref |
|
| Placental |
12 |
25.3 |
0.22 |
(0.03, 1.60) |
| Uterine |
12 |
33.3 |
0.5 |
(0.09, 2.81) |
| Hemoglobin (at delivery) g/dl |
|
|
|
|
| ≥60g/1 |
17 |
35.3 |
Ref |
|
| <60g/1 |
16 |
37.5 |
0.92 |
(0.21, 3.96) |
| aPTT (continuous) seconds |
31 |
– |
1.03 |
(0.99, 1.07) |
| PT (continuous) seconds |
30 |
– |
1.02 |
(0.99, 1.05) |
| Maternal age (in years) |
34 |
– |
1 |
(0.83, 1.20) |
| Gestational age at delivery (in weeks) |
34 |
– |
1.16 |
(0.78, 1.74) |
Table 3: Unadjusted Odds Ratios and 95% Confidence Intervals for the Association Between rFVIIa Treatment, Patient Characteristics, and Maternal Mortality
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